7 Hand assisted laparoscopic splenectomy (hals) in children--our initial experience with the Gelport.
|Article Type:||Perspectiva general de la enfermedad/trastorno|
Laparoscopia (Analisis de casos)
Ninos (Investigacion cientifica)
Ninos (Analisis de casos)
Ninos (Cuidado y tratamiento)
|Publication:||Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658|
|Issue:||Date: June, 2009 Source Volume: 28 Source Issue: 2|
7 Hand Assisted Laparoscopic Splenectomy (HALS) in Children--Our
Initial Experience with the Gelport. Jocel Pagan MS-IV *, Carmen Ramos
MD, FACS, FAAP ([dagger]); * School of Medicine, Universidad Central del
Caribe and Division of Pediatric Surgery, ([dagger]) San Jorge
Children's Hospital, San Juan, Puerto Rico
Introduction: Since 2002, hand assisted laparoscopic splenectomy (HALS) has been advocated as the preferred approach for splenectomy in adults with splenomegaly in the setting of benign and malignant hematological disease. Not only it maintains the advantages of a purely laparoscopic approach but it allows the surgeon to remove the organ intact, especially when the diagnosis of malignancy is equivocal. In children, although it seems feasible and safe, not much has been reported in the surgical literature. We present our experience of operative and post operative results of HALS performed for hematological disease which was equivocal for malignancy in three pediatric patients. Method: In the year 2008, three female patients, ages 10-15 yrs, referred by the Hematology Oncology service, underwent HALS. The procedures were performed using an anterior approach through a semilateral position. In two patients, the Gelport device was used through a Pfannestiel incision for final retrieval of the organ. One patient had an extension of one of the trocar incisions to retrieve the organ. Results: Maximum diameter of the spleens was 16 cm. All spleens were removed intact. Pathological analysis demonstrated one spleen to be a lymphangioma/hemangioma, one was an involuted hematoma with fibrosis and the other a congenital splenic cyst. Operative time ranged from 150-180 minutes. Mean blood loss was 60 cc. There were no complications and the patients were discharged home on postoperative day #3 tolerating a regular diet and oral medications for pain control. Conclusion: Hand assisted laparoscopic splenectomy is a safe and feasible minimally invasive procedure in children with hematological disorders when neoplasm cannot be readily ruled out. Second generation devices such as the Gelport provide an exceptional approach while maintaining the pneumoperitoneum, facilitating the exposure and providing a great cosmetic result.
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